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Defense Department Works to Eliminate Gaps in Medical Care

By Jim GaramoneAmerican Forces Press Service

WASHINGTON, Jan. 22, 2008  The trauma care that U.S. servicemembers receive is the best in the world, but the Defense Department must continue to eliminate gaps in the medical process as patients move from DoD facilities to the Department of Veterans Affairs and to private hospitals, a senior Pentagon medical official said.

Dr. Stephen L. Jones, principal deputy assistant secretary of defense for health affairs, said the military health system’s future hinges on how it will become more efficient and how it will be more transparent to patients and families.

The Defense Department and the Department of Veterans Affairs are working closely together to share medical records, Jones said.

“We have been working to ensure we have secure, global reach of electronic health records,” he explained. “The DoD and VA records would be integrated so when you saw that health provider in the VA, he would have access to the records from when the patient first entered the system.”

Groups appointed to study the system identified the need to fix seams between military and VA medical care, Jones said.

“All of the task forces and commissions said we needed more integration and cooperation between the DoD and VA, and we’ve made tremendous strides,” he said. “Are we where we need to be? No, because health records are a bit more complicated than financial institutions or airlines and such. Many more components have to be included – radiology, nutrition, provider nodes – all of the various aspects that touch you when you are in the health care field.”

Record-sharing may be only the beginning, Jones said. “We are looking, for example, at whether it would behoove us to have one in-patient system that would be used by DoD and the VA,” he said. “That study is under way now, and we will have recommendations in March.”

Another gap that needs to be closed is between government and private-sector health officials, Jones said. Many private health care providers are not as far along as DoD and VA in keeping electronic patient records, he explained, so the records from a beneficiary’s visit to a private physician may not make it into his or her military medical record.

“We need to build a system that will allow the folks working with patients and military families access to the records – whether it be DoD, VA, the state or a private institution,” Jones said. Private-sector health care providers and the government are working to set information technology standards for health care records, he added.

Improved efficiency in Tricare and other third-party insurance payments is another goal for the military health system, Jones said. He also pointed out that Congress has told the Defense Department to address changes in Tricare cost shares. While private insurance plans are indexed to keep pace with inflation, the cost-share portion of Tricare has not changed since 1996, he explained.

As military medicine moves forward, more and more work is going into how the system treats traumatic brain injuries and post-traumatic stress disorders. The department is moving out on these and other aspects of psychological health, Jones said, and Congress has funded additional research into these disorders. “Exciting things are happening and will happen in that area,” he said.

The department has added specialists closer to the front to help warriors with psychological wounds. Jones said the military has come a long way toward eliminating the stigma associated with seeking mental health help, but more needs to be done.

“Let’s erase the stigma associated with psychological wounds,” he said. “Whether it’s a wound to your body or a wound to your mind, it’s the same thing. You need to get assistance.”

Jones said substandard conditions found at Walter Reed Army Medical Center last year gave the department “a black eye.” He noted that the problems at Walter Reed were not in trauma care, but in follow-on care and administrative processes.

“The department has made tremendous strides in trying to improve the care around the wounded warriors and their families,” he said.

At the Military Health Services annual conference here next week, Jones will host a discussion on the future of military health care. This year’s conference theme is “Caring for America’s Heroes.” More than 3,000 attendees are expected.

The conference is an attempt to communicate ideas throughout the force, and also provides an opportunity for DoD leaders to get input from the field, Jones said.

But it all begins with people, Jones said, and the nation’s wounded warriors are in the best possible hands. From the medics and corpsmen on the ground to the doctors at the combat support hospitals to the specialists at Walter Reed and the National Naval Medical Center at Bethesda, Md., all are providing the best trauma care in the world, he said.

“Without that team, without that system, we would not be able to do the job that we are doing,” Jones said. Servicemembers who would have died of their injuries in the past are now surviving, thanks to the commitment, training and medical know-how of those personnel, he said.